<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">
  <div class="form-group">
    <label class="control-label col-xs-12 col-sm-2">{:__('分账接收方类型')}:</label>
    <div class="col-xs-12 col-sm-8">
      <select  id="c-type" class="form-control selectpicker" name="row[type]">
        {foreach name="typeList" item="vo"}
        <option value="{$key}" {in name="key" value="$row.type"}selected{/in}>{$vo}</option>
        {/foreach}
      </select>
    </div>
  </div>

  <div class="form-group">
    <label for="account" class="control-label col-xs-12 col-sm-2">{:__('分账接收方账号')}:</label>
    <div class="col-xs-12 col-sm-8">
      <input type="text" class="form-control" id="account" name="row[account]" value="{$row.account|htmlentities}" data-rule="required" />
      <strong style="color: red">分账接收方类型是商户，是mch_id，分账接收方类型是个人时，是openid</strong>
    </div>
  </div>
  <div class="form-group">
    <label for="account" class="control-label col-xs-12 col-sm-2">{:__('分账接收方全称')}:</label>
    <div class="col-xs-12 col-sm-8">
      <input type="text" class="form-control" id="full_name" name="row[full_name]" value="{$row.full_name|htmlentities}" />
      <strong style="color: red">分账接收方类型是商户，商户全称（必传），分账接收方类型是个人时，是个人姓名（选传）</strong>
    </div>
  </div>
  <div class="form-group">
    <label class="control-label col-xs-12 col-sm-2">{:__('参与分账')}:</label>
    <div class="col-xs-12 col-sm-8">
      <select  id="c-state" class="form-control selectpicker" name="row[state]">
        {foreach name="stateList" item="vo"}
        <option value="{$key}" {in name="key" value="$row.state"}selected{/in}>{$vo}</option>
        {/foreach}
      </select>
    </div>
  </div>
  <div class="form-group">
    <label for="name" class="control-label col-xs-12 col-sm-2">{:__('联系姓名')}:</label>
    <div class="col-xs-12 col-sm-8">
      <input type="text" class="form-control" id="name" name="row[name]" value="{$row.name|htmlentities}" data-rule="required" />
    </div>
  </div>
  <div class="form-group">
    <label for="mobile" class="control-label col-xs-12 col-sm-2">{:__('手机号')}:</label>
    <div class="col-xs-12 col-sm-8">
      <input type="text" class="form-control" id="mobile" name="row[mobile]" value="{$row.mobile|htmlentities}" data-rule="required" />
    </div>
  </div>
  <div class="form-group">
    <label for="group_id" class="control-label col-xs-12 col-sm-2">{:__('身份')}:</label>
    <div class="col-xs-12 col-sm-8">
      <input type="text" class="form-control selectpage" data-source="wanlshop/separate/store_list"
             id="group_id" data-field="group_name" name="row[group_id]"  value="{$row.group_id|htmlentities}" data-rule="required" />
    </div>
  </div>

  <div class="form-group">
    <label for="group_id" class="control-label col-xs-12 col-sm-2">{:__('区域')}:</label>
    <div class="col-xs-12 col-sm-8">
      <div class="form-inline" data-toggle="cxselect" data-selects="province,city,area">
        <select class="province form-control" name="row[province]" id="province" data-url="ajax/area">
          <option value="{$row.province|htmlentities}" selected="">{$row.province_name|htmlentities}</option>
        </select>
        <select class="city form-control" name="row[city]" id="city" data-url="ajax/area">
          <option value="{$row.city|htmlentities}" selected="">{$row.city_name|htmlentities}</option>
        </select>
        <select class="area form-control" name="row[area]" id="area" data-url="ajax/area">
          <option value="{$row.area|htmlentities}" selected="">{$row.area_name|htmlentities}</option>
        </select>
      </div>
    </div>
    </div>
    <div class="form-group">
      <label for="group_id" class="control-label col-xs-12 col-sm-2">{:__('地址')}:</label>
      <div class="col-xs-12 col-sm-8">
        <input type="text" class="form-control" id="address" name="row[address]" value="{$row.address|htmlentities}" data-rule="required" />
      </div>
    </div>
  <div class="form-group layer-footer">
    <label class="control-label col-xs-12 col-sm-2"></label>
    <div class="col-xs-12 col-sm-8">
      <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
      <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
    </div>
  </div>
</form>
